Provider Demographics
NPI:1689708729
Name:IJAZ, ASIFA (MD)
Entity Type:Individual
Prefix:DR
First Name:ASIFA
Middle Name:
Last Name:IJAZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7912 HARTSFIELD DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-6068
Mailing Address - Country:US
Mailing Address - Phone:972-208-9205
Mailing Address - Fax:972-208-9205
Practice Address - Street 1:1445 MAC ARTHUR DR
Practice Address - Street 2:SUITE#122
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-4461
Practice Address - Country:US
Practice Address - Phone:972-245-1200
Practice Address - Fax:972-245-9140
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1621207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH38267Medicare UPIN